Anatomical Anomalies

There are few medical conditions that require therapeutic male circumcision, and the British Association of Paediatric Surgeons/Royal College of Surgeons (2001) statement indicates that pathological phimosis is the one absolute medical indication. However, many men seen in UK GUM clinics are circumcised, a condition which results from the removal of the prepuce.

Female circumcision or female genital mutilation (FGM) or genital cutting is far less commonly seen. Strictly speaking 'circumcision' refers to the excision of the clitoral prepuce; however, this term, when applied to women, is often used to describe a number of different procedures involving alteration and removal of parts of the female genitalia. The term chosen by the World Health Organisation to describe these practices is female genital mutilation (FGM). I shall use this term; but practitioners should be aware that women who have undergone these procedures may refer to them as 'cutting' or 'circumcision'.

FGM has been illegal in the UK since the Prohibition of Female Circumcision Act was passed in 1985, and since 2004 it has also been illegal to take young girls abroad to have the procedure performed. About 74,000 women in the UK have had the procedure, and it has been estimated that about 7,000 girls under 17 are at risk (DfES 2004).

DEFINITION OF FGM

The two most common forms of mutilation are excision and infibulation. Infibulation

Infibulation, also known as pharaonic circumcision, consists of clitoridectomy, excision of the labia minora, and cutting of the labia majora to create raw surfaces, which are then stitched or held together in order to form a cover over the vagina when they heal. A small hole is left to allow urine and menstrual blood to escape (Amnesty International, 2004).

Excision

Excision involves total or partial removal of the prepuce, clitoris and/or labia minora. Other mutilations include pricking, piercing or stretching of the clitoris and/or labia, cauterisation by burning of the clitoris and surrounding tissues, scraping of the vaginal orifice or cutting of the vagina, and introduction of corrosive substances into the vagina to cause bleeding or herbs into the vagina with the aim of tightening or narrowing it. Women who have undergone FGM often experience problems with their sexual, reproductive and general health. They may have difficulty with voiding or menstruating, and be prone to fistula and keloid formation, recurrent urinary tract infections or pelvic infections.

HYPOSPADIAS

Hypospadias is a congenital malformation that occurs in males. Hypospadias results in the urethral opening and meatus being located on the ventral penile surface. The consequence of hypospadias can be problems relating to the direction of urinary flow. These will be more or less severe depending on the location of the hypospadias. Examination of the penis will reveal hypospadias and, if the hypospadias is problematic, the adult male is usually aware of this.